By Ralph Sahakian, D.M.D., P.C.
June 11, 2021
Category: Oral Health
Tags: jaw pain  
ThinkTwiceBeforeYouUndergoBotoxTreatmentforChronicJawPain

There's still much about the underlying nature of chronic jaw joint dysfunction we have yet to unravel. Treating these conditions known as temporomandibular joint disorders (TMDs) may therefore require some experimentation to find what works for each individual patient.

Most TMD therapies are relatively conservative: eating softer foods, taking anti-inflammatory pain relievers or undergoing physical therapy. There have been some surgical techniques tried to relieve jaw pain and dysfunction, but these have so far had mixed results.

Recently, the use of the drug Botox has been promoted for relieving jaw pain, albeit temporarily. Botox contains tiny amounts of botulinum toxin type A, a poisonous substance derived from the bacterium Clostridium botulinum, which can cause muscle paralysis. It's mainly used to cosmetically smooth out small wrinkles around facial features.

Because of these properties, some physicians have proposed Botox for TMD treatment to paralyze the muscles around the jaw to reduce pain and discomfort. While the treatment sounds intriguing, there are a number of reasons to be wary of it if you have TMD.

To begin with, the claims for Botox's success in relieving jaw pain have been mainly anecdotal. On the other hand, findings from randomized, double-blind trials have yet to show any solid evidence that Botox can produce these pain-relieving effects.

But even if it lived up to the claims of TMD pain relief, the effect would eventually fade in a few weeks or months, requiring the patient to repeat the injections. It's possible with multiple Botox injections that the body will develop antibodies to fight the botulinum toxin, causing the treatment to be less effective with subsequent injections.

Of even greater concern are the potential side effects of Botox TMD treatment, ranging from headaches and soreness at the injection site to more serious muscle atrophy and possible facial deformity from repeated injections. There's also evidence for decreased bone density in the jaw, which could have far-reaching consequences for someone with TMD.

The best approach still seems to lie in the more conservative therapies that treat TMD similar to other joint disorders. Finding the right combination of therapies that most benefit you will help you better manage your symptoms.

If you would like more information on treatments for TMD, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Botox Treatment for TMJ Pain.”

By Ralph Sahakian, D.M.D., P.C.
June 01, 2021
Category: Dental Procedures
Tags: aging  
KnowingHowtheMouthandFaceGrowCanImproveBiteTreatment

Correcting a bite problem involves more than applying braces. Orthodontists must consider a wide range of factors, including the type of bite problem involved, complications like impacted or missing teeth, and their patient's overall dental condition.

Orthodontists must also keep in mind the future—how will a treatment implemented now impact a patient's appearance and dental function many years from now? In reality, orthodontists perform these treatments within a dynamic growth environment, especially involving children and teenagers whose mouth and facial structures are still maturing.

And although these growth changes slow in adulthood, they don't stop—orofacial structures continue to change throughout life. For example, a person's lips steadily thicken in size until the mid-teen years, and then slowly thin out over the rest of their lifetime. The distance between the lips both at rest and while smiling may also narrow in later years. Other changes continue to occur in the bones and soft tissues of the mouth and face.

Fortunately, this structural growth follows a fairly consistent track. Although variations do occur, an orthodontist can project the growth changes their patients will undergo as they age, and use that knowledge to plan out bite treatment. With this understanding, orthodontists plan not only what treatments will be needed, but when to perform them, and to what extent.

This may involve a number of treatment stages, spaced out to coincide with regular development. An orthodontist may focus first on general bite correction to bring the teeth and jaws into a reasonable state of alignment. Later, they'll use more refined methods to fine-tune corrections that better align with later adult growth.

More intensive treatments may be necessary to build a foundation for future treatment. For example, orthognathic surgery may be needed to correct a severe case of an over-extended lower jaw. During the procedure, surgeons move the lower jaw to a joint position higher on the skull. This retracts the lower jaw into a more normal alignment with the upper jaw, and can dramatically change the facial profile for the better.

Each orthodontic patient is different, and each requires their own a unique treatment plan. That plan has a greater chance of long-term success by applying knowledge of future growth changes.

If you would like more information on orthodontic treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Understanding Aging Makes Beauty Timeless.”

SmileEnhancementsThatCouldMakeYourWeddingDayLikeNoOther

Each of life's moments are precious—but some are more precious than others. For one like your wedding day, you want to look your very best.

Be sure your teeth and gums are also ready for that once in a lifetime moment. Here are a few cosmetic enhancements that can transform your smile appearance.

Dental cleanings. Having your teeth cleaned professionally not only boosts your dental health, but it can also enhance your smile's brightness. A dental cleaning removes plaque and tartar that can yellow and dull teeth. With plaque out of the way, your teeth's natural translucence can shine through.

Teeth whitening. For an even brighter smile, consider teeth whitening. We apply a bleaching solution that temporarily whitens your teeth. With a little care on your part and occasional touchups, your brighter smile could last well beyond your wedding day.

Tooth repair. A chipped or cracked tooth can ruin an otherwise perfect smile. We can often repair mild flaws by bonding tooth-colored composite resins to the defective area, usually in one visit. Porcelain veneers or crowns can mask more moderate imperfections, but they must be undertaken well in advance of your big day.

Teeth replacements. We can restore those missing teeth ruining your smile with dental implants. An implant replaces the tooth root as well as the crown to create a stable and durable hold that can last for years. But similar to porcelain restorations, an implant restoration could take months—so plan ahead.

Orthodontics. Correcting a bite problem through orthodontics can have a huge impact on your smile. Straightening teeth isn't just for teenagers—you can undergo treatment at any age. And if you opt for clear aligners, no one but you and your orthodontist need know you're wearing them.

Cosmetic gum surgery. Even if your teeth look perfect, too much of your gums showing could detract from your smile. If your “gummy smile” is caused by excess gum tissue, there are a number of plastic surgical techniques that can restructure the gums so that they appear in right proportion with the teeth.

If you want a more attractive smile on your wedding day, see us as soon as possible for a full evaluation and assessment of your needs. Depending on what you need, we have the means to make your smile live up to that moment of moments.

If you would like more information on smile enhancements, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Planning Your Wedding Day Smile.”

KevinBaconsMango-SlicingTrickandOtherWaystoRidFoodBetweenYourTeeth

During the COVID-19 quarantines, stir-crazy celebrities have been creating some “unique” home videos—like Madonna singing about fried fish to the tune of “Vogue” in her bathroom or Cardi B busting through a human-sized Jenga tower. But an entertaining Instagram video from Kevin Bacon also came with a handy culinary tip: The just-awakened film and TV actor showed fans his morning technique for cutting a mango to avoid the stringy pulp that gets between your teeth. After cutting a mango in half, he scored it lengthwise and crosswise to create squares and then turned the mango inside out for easy eating.

With his mango-slicing video garnering over a quarter-million views, the City on a Hill star may have touched a nerve—the near universal annoyance we all have with food stuck between our teeth. Trapped food particles aren't only annoying, they can also contribute to a bacterial film called dental plaque that's the top cause for tooth decay and gum disease.

Unfortunately, it's nearly impossible to avoid stuck food if you love things like popcorn, poppy-seed muffins or barbecue ribs. It's helpful then to have a few go-to ways for removing food caught between teeth. First, though, let's talk about what NOT to use to loosen a piece of stuck food.

A recent survey of more than 1,000 adults found that when removing something caught between our teeth, we humans are a creative lot. The makeshift tools that survey respondents said they've used in a pinch included twigs, safety pins, screwdrivers and nails (both the hammer and finger/toe variety). Although clever, many such items are both unsanitary and harmful to your gums and tooth enamel, especially if they're metallic or abrasive.

If you want a safe way to remove unwanted food debris, try these methods instead:

Brush your teeth: The gentle abrasives in toothpaste plus the mechanical action of brushing can help dislodge trapped food.

Use dental floss: A little bit of dental floss usually does the trick to remove wedged-in food—and it's easy to carry a small floss container or a floss pick on you for emergencies.

Try a toothpick. A toothpick is also an appropriate food-removing tool, according the American Dental Association, as long as it is rounded and made of wood.

See your dentist. We have the tools to safely and effectively remove trapped food debris that you haven't been able to dislodge by other means—so before you get desperate, give us a call.

You can also minimize plaque buildup from food particles between teeth by both brushing and flossing every day. And for optimally clean teeth, be sure you have regular dental office cleanings at least twice a year.

Thanks to Kevin Bacon's little trick, you can have your “non-stringy” mango and eat it too. Still, you can't always avoid food getting wedged between your teeth, so be prepared.

If you would like more information about effective oral hygiene practices, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Daily Oral Hygiene.”

DrawingImpactedTeethOutoftheGumsCouldHelpNormalizeaSmile

We instinctively know when a smile looks normal—and when it doesn't. It could be that something simply looks out of place like crooked teeth. But we might also notice when something is missing—as with one or both of the canine teeth.

The canine teeth align just under the eyes and are recognizable by their pointed ends. When they're missing, the smile looks “incomplete.” But “missing” in this case could mean “invisible”—the teeth are there, but hidden within the gums because they failed to come in properly and became impacted. This often happens on a smaller jaw where other teeth have crowded into the space intended for them.

Fortunately, we may have a remedy, and not just for appearance's sake—any impacted tooth can cause health problems, from gum abscesses to root damage of neighboring teeth. Although this might necessitate their surgical removal, we might also be able to coax them through the gums into better position in the jaw, if they're in a reasonably good position. This could result in both a boost to a patient's oral health and a more normal looking smile.

First, though, a patient will need to undergo a thorough bite evaluation by an orthodontist. Besides pinpointing the impacted teeth's precise location with x-rays or CT technology, an orthodontist will also want to assess the positions and condition of the rest of the teeth. If the conditions are right and there's enough room in the jaw, the orthodontist may recommend drawing the impacted canines into proper alignment in the jaw.

The process starts when an oral surgeon exposes the impacted teeth by surgically cutting through the gum tissue. They then attach a small bracket to the tooth with a tiny metal chain attached, the other end of which is looped over orthodontic hardware attached to other teeth. The tension on the chain by the hardware gradually nudges the teeth downward out of the gums. This is usually done in coordination with other measures to fully correct the bite.

If the procedure is successful, bringing the canines out of impaction reduces the problems those teeth could cause the person's oral health. But just as important, it can restore normality to their smile.

If you would like more information on treating impacted teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Exposing Impacted Canines.”





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Ralph Sahakian, D.M.D., P.C.

14 Lake Avenue Worcester, MA 01604